Middle Cerebral Artery Stenosis: Endovascular and Surgical Options

Jeffrey D. Klopfenstein; Francisco A. Ponce; Louis J. Kim; Felipe C. Albuquerque; Peter Nakaji; Robert F. Spetzler

doi:10.1055/s-2005-871873

Skull Base 2005; 15(3): 175-189
DOI: 10.1055/s-2005-871873

Middle Cerebral Artery Stenosis: Endovascular and Surgical Options

Jeffrey D. Klopfenstein¹ , Francisco A. Ponce¹ , Louis J. Kim¹ , Felipe C. Albuquerque¹ , Peter Nakaji¹ , Robert F. Spetzler¹

¹Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Abstract

ABSTRACT

Atherosclerotic middle cerebral artery stenosis is a rare but potentially devastating cause of cerebral ischemia and stroke. While medical management remains the mainstay for stroke prevention, surgical and/or endovascular intervention is indicated in selected patients. This article reviews the role of surgery and endovascular techniques in the treatment of middle cerebral artery stenosis based on its natural history, pathophysiology, and prognosis when treated medically.

KEYWORDS

Middle cerebral artery stenosis - surgery - bypass - stenting - endovascular - angioplasty

Full Text

References

REFERENCES

1 Mohr J P, Lazar R M, Marshall R S, Gautier J C, Hier D B. Middle cerebral artery disease. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM Stroke: Pathophysiology, Diagnosis, and Management New York, NY; Churchill Livingstone 1998: 427-479
2 Fisher C M. Cerebral ischemia-less familiar types. Clin Neurosurg. 1971; 18 267-336
3 Lhermitte F, Gautier J C, Derouesne C. Nature of occlusions of the middle cerebral artery. Neurology. 1970; 20 82-88
4 Hass W K, Fields W S, North R R, Kircheff I I, Chase N E, Bauer R B. Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA. 1968; 203 961-968
5 Marzewski D J, Furlan A J, St Louis P, Little J R, Modic M T, Williams G. Intracranial internal carotid artery stenosis: longterm prognosis. Stroke. 1982; 13 821-824
6 Wong K S, Li H, Lam W W, Chan Y L, Kay R. Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke. Stroke. 2002; 33 532-536
7 Akins P T, Pilgram T K, Cross III D T, Moran C J. Natural history of stenosis from intracranial atherosclerosis by serial angiography. Stroke. 1998; 29 433-438
8 Caplan L R, Gorelick P B, Hier D B. Race, sex and occlusive cerebrovascular disease: a review. Stroke. 1986; 17 648-655
9 Prognosis of patients with symptomatic vertebral or basilar artery stenosis. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Stroke. 1998; 29 1389-1392
10 Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group. N Engl J Med. 1985; 313 1191-1200
11 Hopkins L N, Martin N A, Hadley M N, Spetzler R F, Budny J, Carter L P. Vertebrobasilar insufficiency. Part 2. Microsurgical treatment of intracranial vertebrobasilar disease. J Neurosurg. 1987; 66 662-674
12 Bogousslavsky J, Barnett H J, Fox A J, Hachinski V C, Taylor W. Atherosclerotic disease of the middle cerebral artery. Stroke. 1986; 17 1112-1120
13 Caplan L, Babikian V, Helgason C et al.. Occlusive disease of the middle cerebral artery. Neurology. 1985; 35 975-982
14 Webster M W, Makaroun M S, Steed D L, Smith H A, Johnson D W, Yonas H. Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J Vasc Surg. 1995; 21 338-344
15 Heyden S, Heyman A, Goree J A. Nonembolic occlusion of the middle cerebral and carotid arteries-a comparison of predisposing factors. Stroke. 1970; 1 363-369
16 Shin Y S, Kim S Y, Bang O Y et al.. Early experiences of elective stenting for symptomatic stenosis of the M1 segment of the middle cerebral artery: reports of three cases and review of the literature. J Clin Neurosci. 2003; 10 53-59
17 Arenillas J F, Molina C A, Montaner J, Abilleira S, Gonzalez-Sanchez M A, Alvarez-Sabin J. Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study. Stroke. 2001; 32 2898-2904
18 Feldmann E, Daneault N, Kwan E et al.. Chinese-White differences in the distribution of occlusive cerebrovascular disease. Neurology. 1990; 40 1541-1545
19 Lyrer P A, Engelter S, Radu E W, Steck A J. Cerebral infarcts related to isolated middle cerebral artery stenosis. Stroke. 1997; 28 1022-1027
20 Segura T, Serena J, Castellanos M, Teruel J, Vilar C, Davalos A. Embolism in acute middle cerebral artery stenosis. Neurology. 2001; 56 497-501
21 Adams Jr H P, Gross C E. Embolism distal to stenosis of the middle cerebral artery. Stroke. 1981; 12 228-229
22 Hinton R C, Mohr J P, Ackerman R H, Adair L B, Fisher C M. Symptomatic middle cerebral artery stenosis. Ann Neurol. 1979; 5 152-157
23 Kremer C, Schaettin T, Georgiadis D, Baumgartner R W. Prognosis of asymptomatic stenosis of the middle cerebral artery. J Neurol Neurosurg Psychiatry. 2004; 75 1300-1303
24 Becker V U, Eckert B, Thie A. Isolated symptomatic stenosis of the middle cerebral artery in younger adults. A clinical and ultrasonic follow-up study of eight patients. Eur Neurol. 1996; 36 65-70
25 Corston R N, Kendall B E, Marshall J. Prognosis in middle cerebral artery stenosis. Stroke. 1984; 15 237-241
26 Schmiedek P, Piepgras A, Leinsinger G, Kirsch C M, Einhupl K. Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg. 1994; 81 236-244
27 Schick U, Zimmermann M, Stolke D. Long-term evaluation of EC-IC bypass patency. Acta Neurochir (Wien). 1996; 138 938-942
28 Kleiser B, Widder B. Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke. 1992; 23 171-174
29 Yonas H, Smith H A, Durham S R, Pentheny S L, Johnson D W. Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg. 1993; 79 483-489
30 Walker M T, Deshmukh S, Harbison D L, Partovi S. CT perfusion imaging. BNI Q. 2001; 17 15-27
31 Charbel F T, Zhao M, Amin-Hanjani S, Hoffman W, Du X, Clark M E. A patient-specific computer model to predict outcomes of the balloon occlusion test. J Neurosurg. 2004; 101 977-988
32 Amin-Hanjani S, Du X, Mlinarevich N, Meglio G, Zhao M, Charbel F T. The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease. Neurosurgery. 2005; 56 75-85
33 Wanebo J E, Zabramski J M, Spetzler R F. Superficial temporal artery-to-middle cerebral artery bypass grafting for cerebral revascularization. Neurosurgery. 2004; 55 395-398
34 Newell D W, Vilela M D. Superficial temporal artery to middle cerebral artery bypass. Neurosurgery. 2004; 54 1441-1448
35 Spetzler R F, Roski R A, Rhodes R S, Modic M T. The “bonnet bypass.” Case report. J Neurosurg. 1980; 53 707-709
36 Mendelowitsch A, Taussky P, Rem J A, Gratzl O. Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery. Acta Neurochir (Wien). 2004; 146 95-101
37 Nussbaum E S, Erickson D L. Extracranial-intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy. Neurosurgery. 2000; 46 37-42
38 Weinstein P R, Baena R, Chater N L. Results of extracranial-intracranial arterial bypass for intracranial internal carotid artery stenosis: review of 105 cases. Neurosurgery. 1984; 15 787-794
39 Ishikawa T, Houkin K, Kamiyama H, Abe H. Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease. Stroke. 1997; 28 1170-1173
40 Isono M, Ishii K, Kamida T, Inoue R, Fujiki M, Kobayashi H. Long-term outcomes of pediatric moyamoya disease treated by encephalo-duro-arterio-synangiosis. Pediatr Neurosurg. 2002; 36 14-21
41 Kinugasa K, Mandai S, Kamata I, Sugiu K, Ohmoto T. Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results, and angiograms. Neurosurgery. 1993; 32 527-531
42 Robertson R L, Burrows P E, Barnes P D, Robson C D, Poussaint T Y, Scott R M. Angiographic changes after pial synangiosis in childhood moyamoya disease. AJNR Am J Neuroradiol. 1997; 18 837-845
43 Nakashima H, Meguro T, Kawada S, Hirotsune N, Ohmoto T. Long-term results of surgically treated moyamoya disease. Clin Neurol Neurosurg. 1997; 99(Suppl 2) S156-S161
44 Andrews B T, Chater N L, Weinstein P R. Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion. Operative results in 65 cases. J Neurosurg. 1985; 62 831-838
45 Vorstrup S, Brun B, Lassen N A. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke. 1986; 17 1291-1298
46 McCormick P W, Tomecek F J, McKinney J, Ausman J I. Disabling cerebral transient ischemic attacks. J Neurosurg. 1991; 75 891-901
47 Holzschuh M, Brawanski A, Ullrich W, Meixensberger J. Cerebral blood flow and cerebrovascular reserve 5 years after EC-IC bypass. Neurosurg Rev. 1991; 14 275-278
48 Powers W J, Grubb R L, Raichle M E. Clinical results of extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular disease. J Neurosurg. 1989; 70 61-67
49 Anderson D E, McLane M P, Reichman O H, Origitano T C. Improved cerebral blood flow and CO₂ reactivity after microvascular anastomosis in patients at high risk for recurrent stroke. Neurosurgery. 1992; 31 26-33
50 Schmiedek P. EC-IC bypass in hemodynamic cerebrovascular disease [comment]. J Neurosurg. 1989; 71 464-465
51 Schmiedek P. Long-term evaluation of EC-IC bypass patency [comment]. Acta Neurochir (Wien). 1996; 138 942
52 Lee J H, Kwon S U, Lee J H, Suh D C, Kim J S. Percutaneous transluminal angioplasty for symptomatic middle cerebral artery stenosis: long-term follow-up. Cerebrovasc Dis. 2003; 15 90-97
53 Marks M P, Marcellus M, Norbash A M, Steinberg G K, Tong D, Albers G W. Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke. 1999; 30 1065-1069
54 Mori T, Fukuoka M, Kazita K, Mori K. Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol. 1998; 19 1525-1533
55 Suh D C, Sung K B, Cho Y S et al.. Transluminal angioplasty for middle cerebral artery stenosis in patients with acute ischemic stroke. AJNR Am J Neuroradiol. 1999; 20 553-558
56 Jiang W J, Wang Y J, Du B et al.. Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients. Stroke. 2004; 35 1375-1380
57 Kim J K, Ahn J Y, Lee B H et al.. Elective stenting for symptomatic middle cerebral artery stenosis presenting as transient ischaemic deficits or stroke attacks: short term arteriographical and clinical outcome. J Neurol Neurosurg Psychiatry. 2004; 75 847-851
58 Gomez C R, Misra V K, Campbell M S, Soto R D. Elective stenting of symptomatic middle cerebral artery stenosis. AJNR Am J Neuroradiol. 2000; 21 971-973
59 Sundt Jr T M, Smith H C, Campbell J K, Vlietstra R E, Cucchiara R F, Stanson A W. Transluminal angioplasty for basilar artery stenosis. Mayo Clin Proc. 1980; 55 673-680
60 Connors III J J, Wojak J C. Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg. 1999; 91 415-423
61 Nakano S, Yokogami K, Ohta H, Yano T, Ohnishi T. Direct percutaneous transluminal angioplasty for acute middle cerebral artery occlusion. AJNR Am J Neuroradiol. 1998; 19 767-772
62 Touho H. Percutaneous transluminal angioplasty in the treatment of atherosclerotic disease of the anterior cerebral circulation and hemodynamic evaluation. J Neurosurg. 1995; 82 953-960
63 Takis C, Kwan E S, Pessin M S, Jacobs D H, Caplan L R. Intracranial angioplasty: experience and complications. AJNR Am J Neuroradiol. 1997; 18 1661-1668
64 Tsai F Y, Berberian B, Matovich V, Lavin M, Alfieri K. Percutaneous transluminal angioplasty adjunct to thrombolysis for acute middle cerebral artery rethrombosis. AJNR Am J Neuroradiol. 1994; 15 1823-1829
65 Jimenez C, Duong H, Olarte M, Pile-Spellman J. Recurrent abrupt occlusion after transluminal angioplasty for basilar artery stenosis: case report. Neurosurgery. 1999; 44 210-215
66 McKenzie J D, Wallace R C, Dean B L, Flom R A, Khayata M H. Preliminary results of intracranial angioplasty for vascular stenosis caused by atherosclerosis and vasculitis. AJNR Am J Neuroradiol. 1996; 17 263-268
67 Kimura T, Yokoi H, Nakagawa Y et al.. Three-year follow-up after implantation of metallic coronary-artery stents. N Engl J Med. 1996; 334 561-566
68 Huang P, Levin T, Kabour A, Feldman T. Acute and late outcome after use of 2.5-mm intracoronary stents in small (< 2.5 mm) coronary arteries. Catheter Cardiovasc Interv. 2000; 49 121-126
69 Han P P, Albuquerque F C, Ponce F A et al.. Percutaneous intracranial stent placement for aneurysms. J Neurosurg. 2003; 99 23-30
70 Benitez R P, Silva M T, Klem J, Veznedaroglu E, Rosenwasser R H. Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery. 2004; 54 1359-1367
71 Fiorella D, Albuquerque F C, Han P, McDougall C G. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery. 2004; 54 6-16
72 Feldman R L, Trigg L, Gaudier J, Galat J. Use of coronary Palmaz-Schatz stent in the percutaneous treatment of an intracranial carotid artery stenosis. Cathet Cardiovasc Diagn. 1996; 38 316-319
73 Mori T, Kazita K, Chokyu K, Mima T, Mori K. Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease. AJNR Am J Neuroradiol. 2000; 21 249-254
74 Lylyk P, Cohen J E, Ceratto R, Ferrario A, Miranda C. Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol. 2002; 23 430-436

Robert F SpetzlerM.D.

c/o Neuroscience Publications, Barrow Neurological Institute

350 W. Thomas Rd., Phoenix, AZ 85013

Email: neuropub@chw.edu